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In-Hospital Study of Combined Trauma Score and Outcome in Poly Trauma

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In-Hospital Study of Combined Trauma Score and Outcome in Poly Trauma Sharma et al., J Surg Clin Pract 2020, 4:1 Journal of Surgery & Clinical Practice Research Article a SciTechnol journal Introduction In-Hospital Study of Combined Trauma leads to demise and disability globally. Global burden Trauma Score and Outcome in of disease study, injuries are accountable for 5.1 million deaths, and 15.2% of disability-adjusted life years lost [1,2]. According to the Poly Trauma WHO more than 1.2 million people die just in road accidents every year and as many as 50 million people are injured or disabled [2]. Sumit Sharma1, Meena NN2, Pratap A2, Saroj SK1, Shukla VK2 and Bhartiya SK1* To compare the severity and clinical outcome of trauma patients, injury severity scoring systems are widely accepted tools, trauma- related mortality depends on factors as injury severity, age, sex, Abstract mode of injury, quality of provided health care, and associated co- Background: Several Trauma scores are utilized to evaluate the morbidities [3]. injured victim. Physiologic, anatomic, combined (anatomic and physiologic) scoring systems are commonly used. There is no Several trauma scores are used to evaluate injured patients, consensus on the best predictor of mortality and morbidity. classified as physiologic, anatomic, and combined anatomic and Aim and Objective: To report in-hospital mortality and disability of physiologic scoring systems [4]. The majority of anatomic injury polytrauma cases in our trauma center. We studied and compare severity scores are based on the Abbreviated Injury Scale (AIS), the the clinical and radiological parameters to trauma scores (RTS most widely used severity scores are the Injury Severity Score (ISS) and NISS) and their outcome. and the New Injury Severity Score (NISS) [5-7]. Methods: The study included all injured polytrauma cases aged Osler et al. states the NISS is the sum of the squares of the three 14-65 years, between June 2015 to July 2017 at Trauma Centre highest injury scores regardless of the body region, the ISS is the sum and Super specialty Hospital, Department of General-Surgery, Institute of Medical Sciences, Varanasi. Pregnant women or of the squares of the injury scores in the three most severely injured patients having preexisting co-morbid conditions were excluded. body regions [5,6]. Various studies comparing the ISS and the NISS, Demographics profile, vital, MOI, NISS, RTS, blood transfusion, the majority of the study on blunt trauma reveals the NISS to be length of stay, and mortality recorded. Cases were divided into superior to ISS [8-11]. two groups: survived and expired. The Revised Trauma Score (RTS) is assessed from the physiological Results: Out of 61 polytrauma cases, 88.5% of cases were responses of injured cases. The physiological parameters that make survived and 11.5% were expired. The mean age at presentation was 38.74 ± 13.22 years (range 18-65 years). Majority 77% of up the Revised Trauma Score are the respiratory rate, systolic blood cases had RTI followed by FFH 21.3% and structural collapse pressure, and the Glasgow Coma Score. Values for the Revised Trauma 1.6%. FAST positive in 47.5%. Out of 61 cases, 12 (19.7%) had Score range from 0 to 7.84, with 0 representing the deceased patient ICU requirement, 40 (65.5%) had blood transfusion and shock in and 7.84 representing a patient with normal physiological parameters 58 (95.1%). [12]. The mean NISS was significantly low in the survived group RTS is the best and globally used physiological trauma scoring (p=0.001) and RTS was significantly high in the survived group as compared to the expired group (p=0.001). The hospital stay system, use of the RTS coded values in the field can allow rapid was also significantly high in the survived group (p=0.049). On characterization of neurologic, circulatory, and respiratory distress comparing the mean change in GCS, SBP, RR, RTS, and NISS at and assessment of the severity of serious head injuries [13]. presentation and discharge which showed statistically significant change (p=0.003, p<0.001, p<0.001, p<0.001, p=0.037). In our Although the existence of several scoring systems there is no study, the cutoff point of NISS for predicting mortality was 20 consensus which one is the better for predicting mortality, to report (sensitivity, 100%; specificity, 73%). The cutoff point of RTS for in-hospital morbidity and disability of polytrauma cases in our trauma predicting mortality was 4.5 (sensitivity, 85%; specificity, 100%). center, we studied and compared in-hospital clinical and radiological Conclusion: Based on observation, the NISS is a better predictor parameters in relations to trauma scores (RTS and NISS) and their compared to RTS in terms of their outcome in polytrauma cases. outcome. Keywords Methods Polytrauma; Injury severity score; New injury severity score Our study is in hospital Prospective study, included all injured polytrauma cases reported between June 2015 to July 2017 at our Trauma Centre, Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University Varanasi. All polytrauma victims aged 14-65 years were included in *Corresponding author: Satyanam Bhartiya, Trauma and Superspeciality Hospital, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, the study, pregnant women or preexisting co-morbidity cases India, E-mail: [email protected] were excluded. The written informed consent was taken from all Received: May 08, 2020 Accepted: May 25, 2020 Published: June 02, 2020 the patients or his/her relatives. The study was approved by the All articles published in Journal of Surgery & Clinical Practice are the property of SciTechnol, and is protected by copyright International Publisher of laws. Copyright © 2019 SciTechnol, All Rights Reserved. Science, Technology and Medicine Citation: Sharma S, Meena NN, Pratap A, Saroj SK, Shukla VK, et al. (2019) In-Hospital Study of Combined Trauma Score and Outcome in Poly Trauma . J Surg Clin Pract 4:1. Institutional Ethical Committee of the Institute of Medical Sciences, proportions, medians, or mean ± standard deviation, as appropriate. Banaras Hindu University, Varanasi. Patients were classified into survived and expired. Comparisons were performed by using Chi-Square, Student t-test, and paired Student Data included patient demographics, Heart Rate (HR), Systolic Blood Pressures (SBP), Diastolic Blood Pressures (DBP), Respiratory t-test whenever applicable. Receiver operating characteristic curves Rate (RR), mechanism of injury, Glasgow Coma Scale (GCS), Revised were plotted to identify the NISS, RTS, and GCS cut off points for Trauma Score (RTS), new injury severity score (NISS), need for blood predicting the mortality. The Area Under the Curve (AUC) was used transfusion, need for exploratory laparotomy, hospital length of stay, to compare the discriminatory power of the scoring system, with an and mortality and disability. AUC of 1.0 considered as perfect discrimination and 0.5 considered as equal to chance. A two-tailed p-value of <0.05 was considered to be The ISS was calculated by giving the AIS score of each injury. The statistically significant. highest AIS score in body region was used, the AIS scores of the three most severely injured body regions were then squared and added Results together to produce the ISS score 1-75. A total of 61 cases were admitted to the trauma center during The NISS was defined as the sum of the squares of the AIS of the the study period. Fifty-two were males (85.2%) and 9 were females patient’s three most severe AIS injuries, regardless of the body region (14.8%). The mean age of patients was 38.74 ± 13.224 years (ranging in which they occurred. from 18-65 years), 37 (60.7%) patients had <40 years age and 24 (39.3%) patients had >40 years age group. Revised Trauma Score (RTS) aimed at identifying severity based on systolic arterial pressure, Glasgow Coma Scale, and respiratory The majority, 47 (77%) cases had motor vehicle injury followed by rate. RTS score (0-12) was calculated (GCS value × 0.9368+SBP value fall from height 13 (21.3%) and 1 (1.6%) structural collapse. FAST was × 0.7326+RR value × 0.2908). positive in 29 (47.5%) and negative in 32 (52.5%). All data analyzed by using the Statistical Package for the Social According to NCCT Head, 15 (24.6%) patients had a contusion Sciences version 23 (SPSS, Inc, Chicago, IL), data presented as and 1 (1.6%) cases have a diffuse axonal injury. Table 1: Comparison of various study variables between survived and expired. Outcome Survived (n=54) Expired (n=7) p-value No. % No. % Age < 40 33 61.1 4 57.1 0.840 ≤ 40 21 38.9 3 42.9 Mean ± SD 38.22 ± 13.026 42.71 ± 15.130 0.402 Gender Male 45 83.3 7 100 0.242 Female 9 16.7 0 0.0 Mechanism injury RTA 41 75.9 6 85.7 Falls 12 22.2 1 14.3 0.823 Structure collapse 1 1.9 0 0.0 Definitive airway 4 7.4 2 28.6 0.077 Hemothorax 23 42.6 2 28.6 0.689 Pneumothorax 20 37.0 2 28.6 0.710 Tension pneumothorax 1 1.9 1 14.3 0.218 Flail chest 2 3.7 1 14.3 0.311 Contusion 9 16.7 0 0.0 0.580 RR 29.33 ± 7.919 30.29 ± 12.175 0.780 Pulse 107.93 ± 16.271 108.57 ± 26.063 0.927 SBP 96.15 ± 13.861 82.57 ± 15.131 0.019 DBP 59.70 ± 11.409 52.57 ± 13.100 0.131 GCS presentation 14.19 ± 2.075 13.43 ± 2.820 0.387 Blood transfusion 34 63.0 6 85.7 0.40 FAST 26 48.1 6 85.7 0.106 Hypothermia 7 13.0 4 57.1 0.016 Shock 52 96.3 6 85.7 0.311 Spine protection 4 7.4 1 14.3 0.532 ICU requirement 6 11.1 6 85.7 <0.001 RTS presentation 7.2504 ± 0.73178 6.0990 ± 1.23611 0.001 NISS presentation 17.39 ± 6.614 26.29 ± 4.990 0.001 Hospital stay 9.50 ± 3.284 6.57 ± 5.884 0.049 RR: Respiratory Rate; SBP: Systolic Blood Pressures; DBP: Diastolic Blood Pressures; RTS: Revised Trauma Score; NISS: New Injury Severity Score Volume 4 • Issue 1 • 1000119 • Page 2 of 4 • Citation: Sharma S, Meena NN, Pratap A, Saroj SK, Shukla VK, et al.
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